Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer

Peptic ulcer perforations are a common emergency, but available literature is silent on the exact definition, incidence, management, and complications of peritonitis due to omental patch leakage. Retrospective data were collected on 422 patients who underwent omental patch repair of perforated peptic ulcer between March 20, 1999 and March 20, 2006. The definitive diagnosis of perforated peptic ulcer and omental patch leakage was obtained at surgery. Seventeen [4%] patients experienced generalized peritonitis due to omental patch leakage. Mean age was 60.6 years. Mortality rate was 29.4%, and the mean hospital stay was 23.6 days. Delay in surgical approach, shock on admission, and age were all significantly associated with increased mortality. Peritonitis due to omental patch leakage can result in significant morbidity and mortality. The most common causes of omental patch leakage and operative procedures were unknown and reinsertion of omentum, respectively. Factors such as shock on admission or delayed surgery, have significantly contributed to fatal outcomes and need careful attention

Giant prosthetic reinforcement of the visceral sac: the stoppa groin hernia repair in 234 patients

Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. Giant prosthetic reinforcement of the visceral sac [GPRVS] is popular in America and Europe, but there are no prospective data from Iran. From 20 March 1995 to 20 March 2003, 234 patients [227 men and 7 women] with 420 inguinal hernias [186 bilateral and 48 unilateral] underwent repair using a large polyester mesh based on Stoppa`s preperitoneal technique. Mean age was 60 years [range 25 to 88] and 44.8% had one or more comorbid conditions. In 154 instances, the relapsed hernia had already been operated once or twice for recurrence. Mean hospital stay after surgery was 2.2 days [range 1-13 days]. The mean operative time was 45 minutes [range 30-75 minutes]. General complications were one case of upper gastrointestinal bleeding, one case of ileus and one case of atelectasis. Local complications consisted of three local seroma formations. In no instance was postoperative neuralgia, chronic pain or testicular atrophy, mesh infection or death reported. Follow-up was obtained in all patients. The recurrence rate was 0.71% [3 of 420] per inguinal repaired or 0.85% [2 of 234] per patient. Factors predicating a high risk for recurrence included large hernia size [>5 cm], failure of one or more previous repairs [65.8%, 154 of 234], chronic cough and associated lower abdominal hernias. GPRVS is anatomic, sutureless, tension-free and the absolute weapon to eliminate all type of groin hernias. No other technique produces better results for the repair of recurrent and re-recurrent groin hernias